AHIP Fraud, Waste, and Abuse (FWA) Practice Exam

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• Under ACA Section 1557, what can health plans charge based on an individual's age?
• If a drug is not covered under a Medicare plan, what is one potential avenue the patient could explore?
• What is the financial exposure Mr. Patel could expect for inpatient hospital services under Original Medicare?
• Which statement accurately describes Section 1557 of the Affordable Care Act (ACA)?
• If a client is interested in a Medicare Advantage plan at the beginning of September, what should the agent do?
• What type of Medicare plan combines both medical and prescription drug coverage?
• Are the Standards of Conduct different for various Medicare Parts C and D sponsors?
• What is the status of Mr. Liu's initial enrollment period for Medicare?
• What is the penalty situation for Ms. Thomas if she enrolls in Part B after her employer group coverage ends?
• What should Madeline Martinez know about enrolling in Medicare Part A?
• What should Mrs. Park do to assist with her Medicare costs?
• Can Mr. Edwards host a magician for a marketing event while complying with Medicare guidelines?
• What impact does moving out of the service area have on Mr. Wilcox's PFFS Medicare Advantage Health Plan?
• What is considered an example of waste in relation to Medicare resources?
• What action will Ms. O'Donnell need to take to switch her MA plans?
• What should beneficiaries enrolled in MA-MSA plans know about obtaining Part D benefits?
• Why is it a misconception that compliance responsibility lies solely with the Compliance Officer?
• Which of the following best describes an annual cost structure for beneficiaries under standard Part D coverage?
• What is true regarding network requirements for Medicare Advantage plans?
• What is required for Ms. Henderson to obtain Medicare Part B coverage?
• Which types of health plans are included in the Medicare Advantage program?
• What does a new Medicare beneficiary need to consider when selecting a Part D plan for existing medications?
• In what situation is it acceptable to provide a gift while marketing Medicare plans?
• What activity would be prohibited for Willard, a representative in the senior marketplace?
• What can Mrs. Johnson expect after her enrollment form is processed by her new plan?
• What must an individual typically provide to enroll in a Medicare Advantage plan?
• Which of the following is NOT a potential penalty for violating FWA laws?
• Which of the following is a benefit of having strong compliance measures in place?
• What does the policy of non-retaliation protect?
• What advice should be given to Mrs. Chi regarding her interest in an MA MSA plan?
• What type of gift can be offered to induce enrollment in Medicare Advantage and Part D plans?
• What is an acceptable activity during educational events according to Medicare guidelines?
• What is the focus of the marketing representative compensation rules established by CMS?
• What should Mr. Diaz be informed about the premium penalty related to Part B enrollment?
• What method should Mr. Lopez use to pay for his Medicare prescription drug plan premiums?
• What is an important consideration for Mrs. Chi regarding her current Part D coverage?
• What should Mrs. Roberts consider when selecting a Private Fee-for-Service (PFFS) plan?
• What must Mr. Gomez do to receive health care services under a Private Fee-for-Service (PFFS) plan?
• When can you discuss a stand-alone prescription drug plan during a meeting?
• What is the correct action if you suspect a prescription is forged?
• What key factor is important when planning a marketing event for seniors?
• Which of the following statements about Medicare Savings Account (MSA) Plans is true?
• Prior to enrolling in a Medicare MSA plan, what should Mrs. Lyons know?
• How does Medicare ensure coverage for specialized medications in therapeutic categories?
• What does Medicare Part B primarily cover?
• When you notice unusual claims from a specific provider, what should you do next?
• What is one condition for Medicare to cover emergency ambulance services?
• If you discover an unattended email or fax machine receiving appeals, what is the best course of action?
• What is the primary benefit of ensuring timely data and billing to prevent FWA?
• Which Medicare programs are affected by ACA Section 1557?
• Who is responsible for compliance within an organization?
• What is the maximum duration for inpatient psychiatric care covered by Medicare?
• How long does Mr. Wilcox have to continue his PFFS coverage after relocating?
• Before switching plans, what should Mr. Rodriguez ensure about his current MA plan?
• True or False: Anyone who knowingly submits false claims to the government is liable for five times the damages caused.
• Which statement describes a captive agent?
• How can individuals help prevent fraud, waste, and abuse?
• What could be a consequence of not enrolling in a Part D plan during the initial eligibility period?
• When is the best time for Mrs. Geisler to reevaluate her Part D options?
• What should you do upon discovering unreported discrepancies about enrollees in a monthly report?
• Which is NOT a misleading assumption about compliance responsibility?
• Which statement is true regarding Mr. Rice’s employer's group health plan when considering enrollment in Medicare Part B?
• What should marketing representatives prioritize when preparing for client appointments?
• Which statement is true about the formulary of a Medicare Part D plan?
• What is a key characteristic of Medicaid coordination with Private Fee-for-Service (PFFS) plans?
• Are all Medicare Parts C and D sponsors required to maintain a compliance program?
• What does the acronym SNP stand for in Medicare terminology?
• In which circumstance can a beneficiary utilize a PFFS plan?
• What can enhance the effectiveness of a compliance program?
• Which service is covered by Original Medicare if the appropriate criteria are met?
• Which of the following scenarios does not imply fraud?
• Which agents are subject to CMS marketing representative compensation rules?
• When assessing a large quantity prescription that seems unusual, what is essential to verify first?
• What is Mrs. Walters advised against when considering a Medicare Advantage plan?
• Which part of Medicare must a beneficiary be enrolled in to access coverage through Medicare prescription drug plans?
• What should be done upon identifying a recurring pattern of unusual claims from a provider?
• What is one of the main objectives of the Part D low-income subsidy program?
• What explanation can you provide to a colleague who believes TMO representatives do not need Medicare training?
• What are Mr. Rodriguez’s options during the MA Open Enrollment Period?
• What are cost containment techniques used by Part D prescription drug plans?
• Which statement is true about Medicare Part B premiums?
• If your plan has a lower premium and unique benefits, how should this information be presented to clients?
• During a presentation for a Medicare Advantage plan, how should you present the plan's ratings to a potential client?
• When is Mrs. Reynolds’s Medicare Advantage plan coverage likely to start?
• What should Mr. Kumar understand about accessing providers in a Medicare Advantage HMO?
• What happens if Mr. Ford decides to switch to a MA-PD plan during the Annual Election Period?
• How often should compliance training be conducted to maintain effectiveness?
• Who among Miles’ clients qualifies for the opt-in simplified enrollment mechanism?
• Which of the following statements about Medicare Part D plans is accurate?
• What should you do if an employer gives you a list of retirees to contact about their plan?
• What determines if Mrs. Paterson is eligible for Medigap benefits?
• What must you obtain before conducting an in-home sales presentation?
• What special eligibility does Mrs. Jenkins have for enrolling in a MA-PD plan?
• What can Mr. Rockwell do because his employer's drug benefits are no longer creditable?
• What is a limitation that Mr. Lombardi faces regarding drug coverage when enrolled in an MA-only PPO plan?
• When is it permissible for an agent to market multiple insurance products?
• What does Medicare cover for cancer screening tests, according to Mr. Buck's inquiry?
• Where can Mr. Wu seek assistance for his prescription drug costs despite failing to qualify for the low-income subsidy?
• How does the premium penalty for Part D affect individuals like Mr. Hutchinson?
• What should Anita Magri be informed about the Medigap Part F plan?
• What should you tell Mr. Anderson regarding his enrollment form submitted for a plan starting January 1?
• Why is it critical to verify all information provided to you?
• Why might Mr. and Mrs. Vaughn's specialized multivitamin prescriptions not be covered under Part D?
• How do Medigap plans assist beneficiaries like Mrs. Paterson concerning costs?
• What is the general guideline for promotional materials for Medicare plans?
• What must compliance programs strive to enhance according to federal guidelines?
• For how many days will Original Medicare cover Mrs. Shields' skilled nursing services without copay?
• How many Initial Enrollment Periods (IEPs) has Ms. Claggett had for Medicare?
• Which group is protected under Section 1557 of the ACA?
• What must Mrs. Kelly do to enroll in a Medicare Advantage plan?
• What is the advantage of enrolling in a Medicare Advantage plan for Ms. Thomas?
• What kind of services might Original Medicare not cover that some Medicare Advantage Plans provide?
• True or False: Once a corrective action plan is initiated, it needs to be monitored annually for effectiveness.
• Which items and services are generally not covered by Medicare?
• What considerations might Mrs. Fiore evaluate when deciding whether to enroll in a Medicare prescription drug plan?
• What is the potential consequence for Mr. Robinson if he fails to pay his MA-PD plan premium?
• Which of the following actions is essential for coordinating with other payers to prevent FWA?
• What is the primary purpose of obtaining a scope of appointment form?
• What does the acronym TrOOP refer to in Medicare terminology?
• What happens to Juan Perez's employer-sponsored healthcare coverage when he enrolls in Medicare?
• When conducting a sales presentation at a senior center where a prize is being offered, what must you clearly state?
• What is the starting point for Mrs. Kendrick to enroll in a Medicare Advantage plan?
• Which of these is NOT a factor relevant to the determination of higher premiums under ACA Section 1557?
• What advice would you provide Mr. Liu concerning his enrollment options?
• Which statement accurately reflects the nature of abuse regarding billing practices?
• What is the maximum amount Dr. Brennan can charge Mary for her treatment under the PFFS plan?
• What costs can Mr. Alonso expect when enrolling in a standard Medicare Part D prescription drug plan?
• What can Mrs. Chou do regarding her interest in a PFFS plan with no drug coverage?
• How should you respond to the suggestion of turning an educational event into a sales presentation?
• What benefit does the Part D low-income subsidy provide to eligible applicants?
• What should Mr. Romero do to determine the best health plan for his prescription needs?
• How can Mr. Schultz avoid a premium penalty when enrolling in Part D?
• How should BestCare Health Plan respond to a state insurance department's request during an investigation?
• When mailing event invitations to new Medicare beneficiaries, what is a consideration for RSVPs?
• What is the significance of TrOOP in Medicare Part D?
• What is the maximum duration of inpatient hospital costs Mr. Patel will have to cover under Medicare?
• What is required for an effective compliance program at a minimum?
• What eligibility criteria must Mrs. Radford meet to enroll in Medicare Advantage?
• What action should be taken if a minor inventory discrepancy is found in controlled substances?
• Which of the following should be reported to a Compliance Department?
• What is a primary functionality of the Compliance Department?
• What does abuse in the context of payment for services typically involve?
• Which option best describes a key purpose of a compliance program?
• How should you process a back-dated enrollment application that violates operational guidelines?
• Can Ms. Stuart obtain drug coverage if she enrolls in a special needs plan (SNP)?
• What happens to Mr. Fitzgerald's stand-alone prescription drug plan when he moves outside its service area?
• What does it mean for Ms. Eisenberg's drug coverage to be classified as "non-creditable"?
• In Mr. Buck's case, what aspect should he verify regarding cancer screenings under Medicare?
• What option does Mr. Singh have for drug coverage without enrolling in a Medicare Advantage plan?
• What option does Ms. Edwards have for filling her lost prescriptions while traveling?
• Which of the following are penalties for violating FWA laws?
• Which of the following might be considered a violation of FWA?
• Which of the following actions constitutes fraud?
• What should Ms. Gibson understand about obtaining drug coverage with her new PPO plan?
• Which practice can significantly contribute to identifying and preventing FWA?
• What is a requirement for all Medicare prescription drug plans regarding therapeutic drugs?
• What restriction should you observe regarding contacting potential enrollees?
• Which of the following is NOT a law governing FWA for Medicare?
• How does the transition to retirement impact Mrs. Peňa's Medicare enrollment?
• What constitutes fraud in federal healthcare programs?
• For which reason might an individual face penalties under Medicare Part D?
• What alternative assistance options does Mr. Bickford have if he does not qualify for the low-income subsidy?
• What types of insurance products can be presented during a Medicare Advantage and Part D marketing appointment?
• Which of the following scenarios is considered involuntary disenrollment from a Medicare Advantage (MA) plan?
• How long does Caring Health have to notify Mrs. Garcia about her enrollment status once CMS replies?
• What is the eligibility requirement for enrolling in a Medicare prescription drug plan?
• What will Mrs. Kendrick need to do if she wants to confirm her enrollment date for an MA plan?
• What is a requirement for Mrs. Parker if she wants to enroll by telephone?
• If there is a Special Needs Plan (SNP) available, when can Mr. Wendt enroll in it?
• How is compliance with ACA Section 1557 monitored?
• What does Mr. Sanchez need to do before enrolling in a Medicare Advantage plan?
• What is required when marketing Medicare Advantage and Part D plans to potential clients?
• If Mrs. Duarte disagrees with a claim denial, what should she do?
• What happens to Ms. Claggett's eligibility for Part D after missing her IEPs?
• What is an outcome of having a compliance program?
• When can a beneficiary enroll in a standalone Part D plan?
• Which statement accurately reflects the status of compliance programs in Medicare?
• What is one of the goals of correcting non-compliance?
• What are the eligibility requirements for Mrs. Walters to enroll in a Medicare prescription drug plan?
• What is Part D of Medicare primarily focused on?
• What describes an example of material misrepresentation in the context of Medicare?
• What is the primary concern when comparing different Medicare plans?
• What should Mrs. Peňa know about enrolling in Part B while on her employer's plan?
• What are the correct means to report potential fraud, waste, and abuse?
• What aspect does ACA Section 1557 rules for disability primarily focus on?
• What benefit do Special Needs Plans (SNPs) provide for enrollees with chronic conditions?
• Which individual enrolled based on a fixed enrollment period?
• Which type of Special Needs Plan (SNP) would likely be most suitable for Daniel, who has chronic bronchitis?
• What is the general coinsurance percentage for services covered under Medicare Part B?
• What is the enrollment change policy during the Annual Election Period?
• What should Mr. Lynn understand about the marketing of Medicare health plans?
• Which of the following statements is true regarding Mrs. Parker's telephone enrollment in a Medicare Advantage plan?
• What is a key feature of Medicare Savings Accounts (MSAs)?
• What can Mr. Zachow do regarding a drug that is not on his Part D plan’s formulary?
• Which of the following items are classified as compensation for a Medicare agent?
• What action should you take upon discovering a minor inventory discrepancy in controlled substances?
• What is one important component of Medicare Advantage Plans regarding out-of-pocket costs?
• What is the primary focus of the Private Fee-for-Service (PFFS) health plans?
• How could a beneficiary determine if a Medicare drug plan offers better benefits than their current coverage?
• How much inpatient psychiatric care will Medicare cover for Mr. Rainey?
• What consequence can result from violations of ACA Section 1557 nondiscrimination rules?
• What criteria determine if Mr. Shapiro qualifies for extra help with Part D prescription costs?
• What can beneficiaries expect from Medigap plans?
• What is a significant change to Medigap plans that took effect recently?